Pregnancy may be complicated by diabetes, either by existing, recognized disease or by gestational diabetes, i.e. diabetes with first diagnosis during the pregnancy. In either case, diabetes has adverse affects both for the mother and for the offspring. Toxemia and cesarean section are both more common in women with diabetes during pregnancy, and malformations, macrosomia, prematurity and perinatal mortality are more common in infants of diabetic mothers. It is also becoming increasingly clear that offspring of diabetic women, even if they escape morbidity in the newborn period, are at an increased risk of obesity and glucose intolerance during childhood and young adulthood. The purposes of the project are to identify diabetes and impaired glucose tolerance during pregnancy in women in the Gila River Indian Community, to determine the effects of abnormal glucose tolerance on outcome of the pregnancy, and to determine long term prognosis for the women and their offspring. The diabetes status of every woman is determined at two-yearly intervals and during the third trimester of each pregnancy. The characteristics of women who have diabetes or impaired glucose tolerance during the pregnancy are compared to those of women who are normal during the pregnancy and subsequently develop diabetes and to those of women who remain normal. The outcome of these pregnancies is assessed by review of both mother's and infant's hospital records. At birth, cord blood is collected for determination of glycosylated fetal hemoglobin, proinsulin, c-peptide and insulin. Maternal blood is also collected for glycosylated hemoglobin. These women and the offspring of their pregnancies after the age of 5 years are followed at two-yearly intervals, with examinations which include measurement of numerous parameters including glucose tolerance, height, and weight. The diabetes status of the fathers of these offspring is also determined so that familial and genetic factors can be evaluated as well as the effects of the intrauterine environment.